Predicting survival in AIDS: refining the model.
We tested the validity of a previously-published AIDS staging system by examining AIDS-defining diseases (ADDs) and CD4 counts as prognostic factors for survival of the 248 AIDS patients in the Edinburgh City Hospital Cohort, of whom 56% were injecting drug-users (IDUs). Cox regression was used to model the proportionality of risk of death as the CD4 count declined and more ADDs were experienced, and dependence upon post-AIDS treatment. Using the system of Mocroft et al. (Lancet 1995; 346:12-17) to grade severity, our data were well enough modelled, but we suggest: (i) regrading of HIV dementia (RR 3.9, 95% CI 2.5-6.0), mainly attributed to the drug users, to a very severe ADD; (ii) reduction in risk from zidovudine (RR 0.7, 95% CI 0.5-1.0) during AIDS follow-up for patients starting treatment at or after AIDS diagnosis; (iii) improved management of first mild ADDs (from 1987-89 to 1994-95: 40% reduction in IDUs appearing with mild index diseases, and an approximate three-fold reduction in risk associated with a mild ADD). This study supports previous findings on the significance of ADDs and lowest CD4 count in predicting the lifetime of AIDS patients.
Hutchinson
S J
SJ
MRC Biostatistics Initiative for AIDS and HIV in Scotland, Centre for HIV Research, Edinburgh, UK.
Brettle
R P
RP
Gore
S M
SM
D015526:AIDS Dementia Complex / Q000401:mortality; D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000401:mortality*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D005260:Female; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D011020:Pneumonia, Pneumocystis / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000401:mortality; D016019:Survival Analysis; D015215:Zidovudine / Q000627:therapeutic use
D019380:Anti-HIV Agents; D015215:Zidovudine